Dimensional and Cross-Cutting Assessment in the DSM-5

With the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; hereinafter referred to as the DSM when used in the general sense) set for release in May 2013, counselors are awaiting changes that may affect how they diagnose. A significant proposed change to the DSM-5 is the addition of dimensional assessments to the categorical diagnoses (American Psychiatric Association [APA], n.d.). The current edition of the DSM (4th ed., text rev.; DSMIV-TR; APA, 2000) uses a categorical classification system. A categorical diagnosis has only two values: the presence or absence of a disorder. Categorical diagnostic systems assume that mental disorders are discrete entities, with relatively homogeneous populations that display similar symptoms and attributes of a disorder. Because client populations are typically heterogeneous and do not fall neatly into diagnostic categories, this assumption has led to many problems and shortcomings with the categorical system (Regier, 2008). Problems such as excessive comorbidity, irresolvable boundary disputes, and excessive use of the not otherwise specified (NOS) categories have become endemic to the manual (First, 2010a, 2010b). To address the limitations of the DSM-IV-TR (APA, 2000) and improve clinical utility, the DSM-5 Task Force is proposing the addition of dimensional assessments to every categorical diagnosis in the DSM. Dimensional assessments are rating scales that measure frequency, duration, severity, or other characteristics of a disorder. The assessments provide additional information to assist counselors with diagnosis, treatment planning, and treatment monitoring. In addition to including dimensional assessments for individual disorders, the DSM-5 Task Force is also proposing cross-cutting assessments to measure diagnostic symptoms commonly seen in